An intersectoral intervention to detect and treat selected somatic chronic diseases in patients with severe mental disease

Abstract

Introduction: Nordic research based on more than one million patient records shows that psychiatric patients live 15-20 years less than the general population. This excess mortality is mainly due to somatic disease, the high prevalence of which among individuals with severe mental disease largely can be attributed to physical inactivity, unhealthy diet and side effects from psychopharmacological drugs. Additionally, research suggests that individuals with severe mental disease do not receive adequate treatment for their somatic diseases. Underdiagnoses and undertreatment of somatic disease are well documented. Knowledge is needed on how to optimize the detection of somatic disease and on how to initiate medical treatment and ensure treatment compliance in this patient group. The study objective is to test an intersectoral intervention targeting individuals with severe mental disease. The intervention aims to optimize the detection of cardiac ischaemia, heart failure, diabetes, hypertension and high cholesterol; to initiate medical treatment; and to ensure treatment compliance. Methods: The intervention includes screening and treatment. The testing of the intervention is conducted as a feasibility study. Patients aged =36 = 65 years who appear in their individual general practitioner's record system with schizophrenia, schizoaffective disorder or bipolar disorder are invited for screening for the selected somatic diseases. Patients diagnosed with somatic disease will receive an individualized course of treatment in general practice in cooperation with the patient and his/her family, and with supervision and support from a local mental health centre, clinical pharmacologists and relevant staff from the municipality. Approximately 350 patients will be identified with severe mental disease in the practices of 18 participating general practitioners. We estimate that around 100 patients will undergo screening. Expectedly, 70% will be diagnosed with somatic disease and undergo treatment. Results: Primary outcome: number of patients screened of those invited to participate; number of patients diagnosed with somatic disease; compliance to scheduled consultations. Secondary outcome: changes in clinical outcomes. Qualitative data will provide insight into the implementation process including participants' experiences with the intervention and the intersectoral cooperation. Discussions: The focus is patient recruitment and adherence to treatment rather than treatment results, as knowledge is sparse on how this is done in the specific patient group. Further, the interventions are developed by using co-design to optimize implementation. Conclusions: The study will provide knowledge about the efficiency of an intersectoral intervention aiming to enhance detection and treatment of selected somatic diseases in patients with schizophrenia, schizoaffective disorder or bipolar disorder. Lessons learned: Diagnostic coding of severe mental diseases within general practice and a close intersectoral cooperation is crucial for optimizing the detection and treatment of somatic disease in patients with severe mental diseases. Limitations: Only patients already identified with severe mental diseases in general practice will be invited to participate in the study. Suggestions for future research: Future research should focus on new interventions on how to enhance detection of somatic disease in individuals whose mental disease is not known in general practice.